Key Practice Recommendations

These key learning points summarize the consensus- and evidence-based recommendations included in this edition. The sources listed here for each statement recommend that physicians perform or implement these actions directly in a clinical setting. A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the Strength of Recommendation Taxonomy (SORT) evidence rating system, go to https://www.aafp.org/afp/2004/0201/p548.

1. For patients with chronic hyponatremia, correct the sodium level at a rate of no more than 8 to 10 mEq/L (8-10 mmol/L) in 24 hours and 18 mEq/L (18 mmol/L) in 48 hours to prevent osmotic demyelination syndrome.
Evidence rating: SORT C
Sources: Section One, references 1 and 4

2. For patients with hyperkalemia who take renin-angiotensin-aldosterone system inhibitor medications (eg, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists) for mortality benefits (eg, heart failure), consider addition of a diuretic or potassium binder to usual treatment.
Evidence rating: SORT A
Sources: Section Two, references 3, 11, 29, and 35

3. For all patients with a suspected acid-base disorder, calculate an initial anion gap, as use of only the serum bicarbonate or pH could result in missing a serious diagnosis.
Evidence rating: SORT C
Source: Section Three, reference 14

4. For patients with asymptomatic primary hyperparathyroidism who do not meet surgical criteria, consider monitoring due to low risk of progression and minimal benefit from parathyroidectomy. Monitoring should include serum calcium and creatinine measurement annually and bone mineral density assessment every 1 to 2 years.
Evidence rating: SORT B
Source: Section Four, references 27 and 29